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J Am Coll Cardiol, 2004; 43:972-978, doi:10.1016/j.jacc.2003.09.059
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: ASPIRIN, NON-STEROIDAL ANTI-INFLAMMATORY, AND CAD

Aspirin dose and six-month outcome after an acute coronary syndrome

Martin J. Quinn, MD, PhD*, Herbert D. Aronow, MD, MPH{dagger}, Robert M. Califf, MD, FACC§, Deepak L. Bhatt, MD, FACC{ddagger}, Shelly Sapp, MS§, Neal S. Kleiman, MD, FACC||, Robert A. Harrington, MD, FACC§, David F. Kong, MD, AM§, David E. Kandzari, MD§ and Eric J. Topol, MD, FACC{ddagger},*

* St. Vincents University Hospital, Dublin, Ireland
{dagger} Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania, USA
{ddagger} Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
§ The Duke Clinical Research Institute, Durham, North Carolina, USA
|| Baylor College of Medicine, Houston, Texas, USA

Manuscript received July 9, 2003; revised manuscript received September 12, 2003, accepted September 29, 2003.

* Reprint requests and correspondence: Dr. Eric J. Topol, Department of Cardiovascular Medicine, Desk F 25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
topole{at}ccf.org

OBJECTIVES: This study was designed to compare the efficacy of low and intermediate aspirin doses in acute coronary syndromes.

BACKGROUND: Little is known of the comparative efficacy of low and intermediate aspirin doses in this setting.

METHODS: We compared six-month death, myocardial infarction (MI), and stroke in patients with unstable angina or acute MI discharged while receiving low (<150 mg) or intermediate (≥150 mg) aspirin therapy in the GUSTO IIb and PURSUIT trials (n = 20,521). We used multivariable analysis and performed a propensity analysis in order to adjust for baseline imbalances between the groups.

RESULTS: Aspirin doses <150 mg were prescribed to 29.9% (6,128) of patients. By six months, 6.4% of the patients (1,310 of 20,521) had a primary event, 6.2% of the patients receiving <150 mg and 6.6% of the patients receiving aspirin doses ≥150 mg (hazard ratio [HR] 1.06 [95% confidence interval (CI) 0.94 to 1.19], p = 0.35). After adjusting for baseline imbalances and the propensity score for discharge aspirin dose, there was no effect of aspirin dose on the composite end point at six months (HR 0.92 [95% CI 0.79 to 1.07], p = 0.28). However, the higher aspirin dose was associated with a reduction in six-month MI (HR 0.79 [95% CI 0.64 to 0.98], p = 0.03). The outcome was similar when patients were matched on the basis of the propensity score for aspirin dose (HR for death/MI/stroke 0.94 [95% CI 0.80 to 1.12], p = 0.51), although stroke occurred significantly more frequently among patients receiving the higher aspirin dose (HR 1.74 [95% CI 1.01 to 3.02] p = 0.05) and the effect on MI was no longer apparent.

CONCLUSIONS: Although these data are non-randomized, they suggest that the aspirin dose upon discharge may influence the clinical course after unstable angina or acute MI.

Abbreviations and Acronyms
  ACS = acute coronary syndrome
  ALDUSA = Aspirin at Low Dose in Unstable Angina
  ATACS = Antithrombotic therapy in Acute Coronary Syndromes Study Group
  CARS = Coumadin Aspirin Reinfarction Study
  CHAMP = Combination Hemotherapy and Mortality Prevention
  CI = confidence interval
  DUCCS-II = Duke University Clinical Cardiology Group Study-II
  ECG = electrocardiographic
  GUSTO IIb = Global Use of Strategies to open Occluded coronary Arteries
  HR = hazard ratio
  MI = myocardial infarction
  PURSUIT = Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy
  TxA2 = thromboxane A2




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